Prior authorization
Get complete cases to clinical review sooner.
Before a clinician reviews anything, a multi-page packet has to be received, read, validated, and checked against policy. We automate that intake so a complete, decision-ready case reaches the right reviewer. The clinical determination stays with your clinicians.
The determination is clinical. The work in front of it is not.
Prior-authorization requests arrive as multi-page packets by fax, email, and portal, hundreds of thousands a month at a large plan. Each one has to be digitized, classified, read, and validated before a clinician can begin. That work is manual, slow to clear, and often outsourced to a vendor priced per document and per page, so the cost grows as volume grows.
As payers remove prior-authorization requirements for routine services, the requests that remain are the complex, exception-heavy ones. That makes the intake work matter more, not less: when only the harder cases are left, getting each one to a clinician complete and on time is what decides turnaround and cost.
We read, validate, and route the packet as it arrives.
The intake runs from receipt to an indexed, decision-ready record in the systems you already run. Anything below confidence goes to a person, with a record of each step.
What the intake automation covers
Multi-channel intake
Receive requests from fax, email, portal, and file drop into one queue, so nothing is tracked in a separate inbox.
Read and classify
Read every page, identify the document types, and split the packet into its parts, regardless of how it was sent.
Extract and validate
Pull member, provider, procedure codes, and dates, and check the packet for completeness against policy before it reaches a reviewer.
Route to the right reviewer
Send a complete, indexed case to the right queue, with anything below confidence routed to a person instead.
Write back to your systems
Land the indexed record in the ECM and systems you already run, so there is nothing to copy or reconcile later.
A record of every step
Keep a record of what was read, checked, and routed, so the intake stays auditable and a person owns anything consequential.
Per-page outsourcing grows with volume. Automated intake does not.
A per-document, per-page contract costs more every time volume rises. Automating the intake changes that: the cost no longer tracks the page count, so the savings hold as volume moves rather than eroding.
Priced per document and per page
The invoice rises with every new packet and every volume spike. Cost scales with the work, in lockstep.
Priced on the platform, not the page
Processing more pages does not grow the bill the same way, so rising volume stops being a rising cost.
A national plan took 70 million pages a year off a per-page contract.
One of the largest member-owned health insurers in the U.S., with 30 million members and 10,000+ hospitals, was receiving nearly 300,000 prior-auth faxes a month and paying a vendor more than $7M a year to process them, with the invoice climbing as volume grew. We moved the intake off the per-page contract and onto automated processing, with low-confidence items routed to people.
Read the case study →Figures are the customer’s own, pre- and post-deployment.
Let’s look at where your prior-auth intake slows down.
Tell us how prior-auth packets arrive today, where they wait before a clinician sees them, and what you pay to process them. We will identify where the manual intake can come out so complete cases reach review sooner.